Clamping and knot tying instrument



L. TROMBETTA CLAMPING AND KNOT TYING INSTRUMENT Dec. 7, 1948.

3 Sheets-Shet 1 Filed Sept. 9, 1.946

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BY ATTORNEY Dec. 7, 1948. L. TROMBETTA 2,455,833

CLAMPING AND KNOT TYING INSTRUMENT Filed Sept. 9, 1946 s shee ts sheet 2 IN VEN TOR.

39 FM BY WWW ATTORNEY 1.. TROMBE ZTTA CLAMPING AND 'KNOT TYING INSTRUMENT Dec. 7, 1948.

Fiied Sept. 9, 1946 3 Shee ts-Sheet a INVENTQR. BY wax/w ATTORNEY Patented Dec. 7, 1948 r est STATES PATENT ()FFlCE cLAMrIN'o AND KNOT TYING INSTRUMENT Louis'lrombetta, Bronx, N. Y. Application September 9,1946, Serial No. 695,616

14 Claims.

This invention relates to clamping and knot tying instruments andmore specifically to a surgical instrument capable of clamping and suturing ancbject as a blood-vessel.

The normal method of suturing "an object as a blood vessel is by drawinga ligature or cord under and about the object and then weaving it into a knot by means of aligature carrier, The instrument employed is a simple forceps and is used as an extension of the fingers. Knot carriers for formed ligature knots have beendesigned but not used. These designs show simple forceps with a hook for retaining the knot but no means of displacing the knot from the forceps, positioning it on the object, or for tightening the knot.

The success of an operation, to a great extent depends on the speed and sterilitywith which it is performed. The instruments previously discussed do not addgreatly to the speed ofthe operation or increase its sterility as they do not reduce or lessen materially the number of the manual movements of the operator, or increase'the sterility' of the operation by permitting the operator to retain his handsout ofcontact and at a distance from the scene'of the. operation. In addition, these instruments require guided, precise and 'skilful' manipulation and a complete View of the operating field. I

The presently described instrument has been inv ented and designed with the express aim of decreasing the number ofthe manual movements or the operator in cl-ampinga-nd Iigaturingnrsutuning an object, and of permitting the operator toapply =a ligature knot without observing thetuneti'o'ning parts of the instrument or the object about which the knot is being tied during the ligaturing.

Often it is an open question in the mind of the operator whether a blood vessel will close by itself and stop bleeding or will require a suture or ligature knot. 'In such a case the operator may apply 'a'needl'ess ligature or knot or may apply a clamp and later have to replace the clamp with akniot. The present' instrument isdesigned tobypass thisproblem as the clampingand knot tying device can be 'used first asa clamp and subsequentlybe operated to tie the ligature;

l he 'instrumentis designed also for tonsillecto m les where the patients "mouth is small as a chil d s, abdominal and other operations where the blood vessels and other elements which mustbe sutured ortied are in hidden, partly'obscured obstructed positions into whioh it is d i fiicult to reaoh and -manipu'lateinstruments or the fingers.- I I Often in an operation, a plurality of elements must beti'ed up or knotted, requiring, in the instruments heretofore used, a re-threading or an individual instrument for each knot, resulting in either an increase in the time spent in the operation or in the number of instruments used. In order to overcome this situation, the present. instrument is designed in two parts, one being a. forceps and the other a multiple of pro-loaded cartridges, any one of which can be quickly and easily positioned on the forceps. This structure, therefore, permits the use of a single pair of forceps andprovides-forquick loading as the knots can be formed, positioned and sterilized on its cartridge prior to the operation.

In detail, an object of the invention isto produce a combination clamp and. knot tier which can function as a clamp or a knot tier or both.

Another object is to produce a combination instrument which can be operated speedily and mechanically as a knot tier without skilled manipulation or observation.

A further object is to form a forceps and ligature knot carrying cartridge instrument in which the oartrid'gecan be easily and quickly assembled or disassembled on the forceps.

Another object is to form a knot carrying and ejecting forceps which can be operated without the use of. any extraneous means to deposit the knot and which instrument is of a size and nature as to be operable in small openings and in difficult positions.

A further object is to form an instrument of the above type which is easily taken apart and is of simple design so that it can be cleansed and sterilized thoroughly.

These and other objects are accomplished by forming my forceps and ligature knot carrying and tightening instrument of a pair of forceps, a knot carrying cartridge and a stop means, the cartridge being tel'escopingly formed of an inner and outer element, the inner element in its extended position having an exposed surface capable of carrying a knot and the outer element being capable of overriding the inner element and eiecting the knot-so carried'therefrom and the spring positioned between the inner andouter elements and being capable of transmitting longitudinal pressure from the outer element to the inner element and the stop means partly positioned on'and functioning between the inner element and the jaws of the forceps to stop a forward travel of the inner element when its forward end becomes aligned'with the forward end of the jaws, whereby a forward travel of the outer-element, through the spring, carries the inner element toward the jaws until halted by the stop means and further advance of the outer element, after the inner one has stopped, overrides its end carrying the knot and ejects it onto and about the object gripped by the jaws. A longitudinally slidable ring carried by the outer element and bearing the ends of the knot in catches can be retracted now tightening the knot.

For further comprehension of the invention, and of the objects and advantages thereof, reference will be had to the following description and accompanying drawings and to the appended claims in which the various novel features of the invention are more particularly set forth:

In the accompanying drawings, forming a material part of this disclosure:

Fig. l is a perspective view of a forceps and ligature knot carrying, ejecting and tightening instrument comprised of a pair of forceps and a cartridge.

Fig. 2 is a perspective view, partly cut away, of the cartridge, showing its knot carrying element, stop means and knot tightening element.

Fig.3 is a detail, partly, in section, of the stop means.

Fig. 4 is a plan view, partly cut away, of the instrument showing the forceps, its jaws and handle and the cartridge.

Fig. 5 is-a plan View showing the cartridge in a retracted position, the jaws of the forceps and a ligature knot positioned about the knot carrier of the cartridge with the knot ends supported in their catches.

Fig. 6 is a sectional view along the line of 6-6 of Fig. 4.

Fig. '7 is a sectional view along the line of 1-7 of Fig. 4:,

Fig. 8 is a sectional view along the line of 88 of Fig, 4.

Fig. 9 is a sectional view along the line of 9-9 of Fig. 4. i

Fig. 10 is a plan view of the cartridge and jaws, the cartridge in a retracted position, with its knot carrier supporting a ligature knot, the knot ejector retracted and-the jaws gripping a blood Vessel.

Fig. 11 is a plan view of elements shown in Fig. 10 but with the cartridge advanced, with its knot carrier aligned with the jaws, the knot ejector aslo aligned with the jaws and knot carrier and having ejected or forced the loose knot from about its carrier-onto and about the blood vessel.

Fig. 12 is a plan view of the elements shown in Figs, 10 and 11 but with the knot tightener retracted and the knot tightened about the blood vessel.

' Fig. 13 is a fragmentary view of the jaw and rod part of the forceps.

In the drawings and in the specifications, in which identical numbers represent similar elements, a clamping and ligament tying surgical instrument 2|] is shown comprised of a pair of forceps 2| and a ligature carrying and tying tubular cartridge 22, slideably and detachably mounted thereupon, the forceps 2| being able to grip and hold a vein, artery or element about which and while the ligature knot is to be tied, and the cartridge carrying the ligature with a pro-formed, loose knot in its forward part and being able to slide the knot onto and draw it tight about the artery.

The pair of forceps is comprised of a jaw motivating handle mechanism 23, a tubular rod 24, a solid rod and a pair of jaws 26. The

4 handle mechanism 23 operates the jaws through the tubular and solid rods, which act together with the handle elements as a toggle linkage to open and close the jaws as the handle elements are spread and converged manually.

In detail, the handle mechanism 23 is formed of a pair of finger grips 21 and a pair of links 28, each of the grips having an integrally formed bent arm 29, which arms extend toward each other with their ends overlapping and resting over an end of the solid rod. A pin pivotally secures the arm ends and solid rod together. The links 28 extend between the bent arms and an end of the tubular rod, pins 3| rotatably secur-' ing ends of the links to the bent arms intermediate the grips and the pin 30, and pin 32 securing the overlapping ends of the links to the end of the tubular rod. The tubular rod 24, which encases and slideably holds the solid rod 25 is provided with a cut away section 33 which permits the pinned ends of the bent arms to rest in close contact with the solid rod, and the arm ends and solid rod to travel together longitudinally of the tubular rod. Thisarrangement of pivoting the ends of the bent arms to the solid rod and linking an intermediate part of the bent arms to the tubular rod permits a longitudinal articulation of the solid rod relative to the tubular rod when the finger grips at the free ends of the bent arms are operated.

The jaws 26 are formed at the ends of the tubular and solid rods, 24 and 25, respectively, removed from the handle. One jaw element 34, of the jaws 26 is formed at the end of and integral with a solid section 35 of the tubular rod,

positioned adjacent the end of the solid rod 25..

The other jaw element is rotatably secured at one of its ends by a pin 3! to the solid section 35 of the tubular rod, and intermediate its ends but in the vicinity of the pin 37, it is rotatably secured by a pin 38 to the solid rod 25. The

jaw element Be is thus hinged by the pin 3'l to rod end during the rotation of the pin 38 about the pin 31. i

Locking means to hold the finger grips, and through them the jaws, in any desired position is provided by forming projections 39 on each of the finger grips. The projections extend toward each other and overlap, and opposite faces of the projections are provided with opposing teeth 40 which form a ratchet, the teeth;

being capable of engaging and holding static the finger grips until a superior manual operative force is applied.

The cartridge 22 is comprised of a tubular element 4| which telescopingly carries within an enlarged portion 42 of its bore 43 at one of its ends, a slidable ligature knot carrier 44 and about itself at its other end, a slidable ligature end bearing piece 45. The cartridge is positioned on the tubular rod 24 with the carrier 44 at the jaw end and the piece 45 at the handle end of the instrument. A ligature 46 is formed with a loose knot 4! resting about the end of the carrier extending from the tubular element and with the ligature ends resting in catches 48 on the gripping the end portionsof the-knot and being,

slidably positioned on the instrument to move away from the deposited knot and draw it tightly.

2. An instrument for clamping an :object and depositing a knot thereabout, comprised of a pair of forceps, tubular knot carrying means and tubular knot ejecting means, the knot carrying means slidably positioned on and carried by the forceps.

and the ejecting means positioned about the car rying means and co-acting with the carrying means to remove the knot. fromv theicarrying means to the object.

3. An instrument for clamping an object and depositing a knot thereabout, comprised of gripping means capable of holding the objectand knot carrying and depositing means, the said means tubularly, longitudinally, slidably encasing the gripping means and having tubular telescoping elements relatively longitudinally s1idable and the inner of said elements having in its extended position, an exposed'portion capable of carrying a knot.

4. An instrument for clamping an object and depositing a knot thereabout, comprised of forceps gripping means capable of holding the object and knot carrying and depositing means, said knot.

carrying and depositing means being longitudinally slidably secured to the forceps means and. having telescoping elements, the inner of said elements in its extended position having an exposed end' portion capable of bearingthe knot thereabout and the outer of said elements being capable of overriding the endportion and dis placing the knot therefrom.

gripping means capable of holding the objectand knot carrying and depositing means, said knot carrying and depositing means being longitudinally slidably secured to the forceps means and having telescoping elements, the inner of said elements in its extended position having an exposed end portion capable of bearingthe knot thereabout and the outer of said elements being 6. An instrument for clamping an object and depositinga knot thereabout, comprised of a gripping means and means longitudinally slidably secured to said gripping means, said slidable means being removable and assemblable to said 7 gripping means and being able to be provided with a cord for tying a suture while in its disassembled state, said longitudinally slidably secured means having a piece longitudinally slidably disposed relative to itself to force a knot therefrom.

7. An instrument for clamping an object depositing a carried knot thereabout and drawing the knot tight, comprised of a pair of forceps and a cartridge, said forceps having handles, a toggle mechanism and jaws, the handles and jaws being positioned at opposite ends of the toggle mechanism and the jaws being articulatable by the handles through the toggle mechanism and the cartridge being disposed longitudinally and slidably on the toggle mechanism and having. telescoping sections and a ring, the inner one of said sections in its extended position having in its extended position an exposed surface carry- '5. An instrument for clamping an object and depositing a knot thereabout, comprised of forceps.

ingithe knotand the outer of said tions being capable of overriding the inner sec-' tion and, forcing its knot from its surface, and

the -ring being slidably disposed on the outer section and having-catches suitable for carrying theends of the knot-whereby after the outerisectionv had overridden the inner section and deposited the knot the ring can be slid away from the knot and tightened. V.

8. An instrumentfor clamping an object. depositing a carried knot thereabout and drawing the knottight, comprised of a pair of forceps, a stop and a cartridge, said forceps having handles, a' togglemechanism and jaws, the'handles and jaws being positioned at opposite ends of the toggle mechanism and the jaws being articulatable by the handles through the toggle mechanism and the cartridge being disposed longitudinally and slidably on .the toggle mechanism and having telescoping sections and a ring, the inner one of said sections in its extended position having in its extended position an exposed surface carry ing the knot and the outer of said telescoping sections being capable of overriding the inner section and forcing its knot from its surfacaiand;

the ring being slidably disposed onthe outer section and having catches suitable for carrying the ends of the knot, and the stop being positioned and functioning between the jaws of the forceps and the inner section whereby'the forward travel of the inner section can .behalted permittingv the outer section to override the inner and deposit, the knot carried thereon andv the ring can he slid away from the knot to tighten it. 1 1

9. An instrument for clamping an object dcpositing a carried knot thereabout. and drawing the knot tight, comprised of a pair of forceps, locking means therefor, and a cartridga'said forceps having handles, a toggle mechanism and laws, the handles and jaws being positioned at opposite ends of the toggle mechanism and the jaws being articulatable by the handles through. the toggle mechanism, the locking means '-po-' sitionedin the handle gripping means and formed of co acting, adjacent oppositely positioned projections to' hold the gripping means in a clamping position, and the cartridge being disposedlongitudinally and slidably on the toggle mechanism and having telescoping sections and a ring, the inner one of said sectionsin its extended position having in its extended position an; ex-

posed surface carrying the knot and the outer of said telescoping sectionsi being capable of overriding the inner section and forcing its knot from and a stop means, the pair of forceps having.

handles, rods and jaws, the handles and jaws being positioned at opposite ends of the'rods and the I jaws being articulatable by the handles through the rods, the knot carrying means'be-" ing tubular in shape and extending slidably about the rodsgthe knot ejecting means being tubular in shape and extending slidably about the rods, the'knot ejecting means-being tubular in shape and extending slidably about the knot carrying means and in contact therewith to transmit a longitudinal motion thereto, and the stop means telescoping set-v having a coacting projection on the jaws and a pin on the knot carrying means whereby the travel of the knot carrying means is terminated at the stop without impeding the travel of the knot ejecting means which can override the carrying means and deposit the knot.

11. An instrument for clamping an object, and depositing a knot thereabout, comprised of a pair of forceps, and a cartridge; said forceps having handles, a toggle mechanism and jaws, the handles and jaws positioned at opposite ends of the toggle mechanism and said handles being capable of articulating the jaws through the toggle mechanism and the cartridge longitudinally slidably positioned on the toggle mechanism and being capable of being advanced onto the jaws, having telescoping elements and a spring, the inner element having in its extended position an exposed surface capable of containing a knot and the outer element being able to override the inner element and eject the knot therefrom and the spring bein positioned between the inner and outer elements and able to transmit force from the outer element to the inner element whereby when the outer element is advanced towards the jaws it urges the innerelement towards the jaws.

12. An instrument for clamping an object, and depositing a knot thereabout, comprised of a pair of forceps, a cartridge and a stop means, said forceps having handles, a toggle mechanism and jaws, the handles and jaws positioned at opposite ends of the toggle mechanism and said handles being capable of articulating the jaws through the toggle mechanism and the cartridge longitudinally slidably positioned on the toggle I mechanism and being capable of being advanced element whereby when the outer element is advanced towards the jaws it urges the inner element towards the jaws until the projection of the inner element co-acts with the projection of the jaws.

13. A surgical cartridge capable of carrying a suture knot for use with a pair of forceps comprised of telescoping tubular elements, a spring therebetween and a stop means on the inner of said telescoping elements, the inner element in its extended position having an exposed surface capable of bearing the knot and the outer element being capable of co-acting with the inner element to eject the knot therefrom and the stop being positioned to extend into the bore of the inner element to retain the cartridge on a pair of forceps.

14. A surgical cartridge, for carrying a suture knot, capable of use with a pair of forceps, comprised of co-acting tubular elements, a spring and a stop means, one of said tubular elements having an exposed surface capable of bearing the knot and the spring positioned and functioning between the tubular elements to transmit longitudinal pressure from the one to the other and the tubular element bearing the knot so positioned in relation to the other element that a relative movement of the other to the one causes the knot to be ejected therefrom and the stop means being retractably positioned in the bore of the one so that the cartridge can be assembled on a pair of forceps and yet act as a stop to limit the travel of the one tubular element.

LOUIS TROMBETTA.

REFERENCES CITED UNITED STATES PATENTS Name Date Gould et al Apr. 19, 1927 FOREIGN PATENTS Country Date Great Britain June 1, 1933 Number Number 

